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Grønneberg SV, Engebretsen E, Løkkeberg ST. Stories of Hope: Young People's Personal Narratives About ADHD Put Into Context of Positive Aspects. QUALITATIVE HEALTH RESEARCH 2024; 34:48-60. [PMID: 37918375 PMCID: PMC10714684 DOI: 10.1177/10497323231206936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
There is a growing acceptance that ADHD is a multi-dimensional disorder in which not all symptoms are associated with deficits or functional impairments. This article contributes to research on the positive aspects of the diagnosis, specifically understanding the positive aspects of living with ADHD. The empirical data was based on individual interviews and self-narratives of 10 young adults with ADHD. Narrative analysis was implemented when investigating their stories. The findings showed that challenges with the diagnosis were not necessarily stably occupied, and for some, the diagnosis was thought of as a benefit and something they would not have been without. Four stories highlighted particularly the context of positive aspects: (1) insight and strategies, (2) targeted efforts, (3) balanced energy, and (4) social skills. These aspects were correlated to both the individual's strengths as well as the strengths and support that could be related to their societal and cultural environment.
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Affiliation(s)
- Siv Vea Grønneberg
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
| | | | - Stine Torp Løkkeberg
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
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Grønneberg SV, Engebretsen E, Torp Løkkeberg S. When ADHD knocks on the door - discourse theory as a frame to explore subject positions and mental wellbeing before diagnosis. Int J Qual Stud Health Well-being 2023; 18:2209964. [PMID: 37155151 PMCID: PMC10167886 DOI: 10.1080/17482631.2023.2209964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
PURPOSE Attention deficit hyperactivity disorder (ADHD) is currently the most prevalent childhood psychiatric diagnosis. This article reports how 10 young adults in Norway positioned themselves before they were diagnosed with ADHD either during early childhood or adolescence. A central theme is how these subject-positions relate to societal norms and mental well-being. METHOD Individual interviews were conducted, and the transcriptions of the interviews were analysed according to discourse theory. RESULT Six central subject positions were identified which in turn related to two major positions: 1) failure with schoolwork and 2) struggle in social interaction. The findings indicated specific emotional and environmental needs and that individuals were confronted with societal norms related to the criteria for ADHD prior to and regardless of whether one had received a formal diagnosis. CONCLUSION We argue that analysing subject positions provides important knowledge regarding ADHD that is useful for individuals, parents, teachers, practitioners, policymakers, and helping professionals in the field of mental health and education when it comes to interventions that support children who possess different temperaments.
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Affiliation(s)
- Siv Vea Grønneberg
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
| | | | - Stine Torp Løkkeberg
- Faculty of Health, Welfare and Organisation, Østfold University College, Fredrikstad, Norway
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van Langen MJM, Szőke R, Rijkelijkhuizen DNJ, Durston S, van Hulst BM. Lost in explanation: internal conflicts in the discourse of ADHD psychoeducation. BMC Psychiatry 2022; 22:690. [PMID: 36348316 PMCID: PMC9644452 DOI: 10.1186/s12888-022-04327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Psychiatric classifications are understood in many different ways. For children with ADHD and their parents, psychoeducation is an important source of information for shaping their understanding. Moreover, psychoeducation is often taken by children and parents to represent how their story is understood by the therapist. As a result, the way psychoeducation is formulated may affect the therapeutic alliance, one of the most robust mediators of treatment outcome. In addition, psychoeducation may indirectly influence the way we understand psychological differences as a society. METHODS To better understand how the classification ADHD is given meaning through psychoeducation, we analyzed 41 written psychoeducational materials from four different countries; the USA, UK, Netherlands and Hungary. RESULTS We identified five patterns of how the materials construct the discourse on ADHD. Notably, tension between biomedical and psychosocial perspectives resulted in conflict within a single thematic stance on ADHD as opposed to a conflict between parties with a different vision on ADHD. There were only few differences between countries in the way they constructed the discourse in the materials. CONCLUSIONS These conflicts cause confusion, misrepresentation and decontextualization of ADHD. Ultimately, for those diagnosed with ADHD and their parents, conflicting information in psychoeducation materials may hamper their ability to understand themselves in the context of their difficulties.
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Affiliation(s)
| | - Rebeka Szőke
- University Medical Center Utrecht, Utrecht, The Netherlands
- Doctoral School of Biology, Institute of Biology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Dominique N J Rijkelijkhuizen
- University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Sarah Durston
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Branko M van Hulst
- University Medical Center Utrecht, Utrecht, The Netherlands
- LUMC Curium - Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Erlandsson SI, Hornborg C, Sorbring E, Dauman N. Is ADHD a way of conceptualizing long-term emotional stress and social disadvantage? Front Public Health 2022; 10:966900. [PMID: 36424967 PMCID: PMC9680974 DOI: 10.3389/fpubh.2022.966900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevalent, neuropsychiatric, deficit perspective on children and youth diagnosed with ADHD prohibits a multidimensional approach where socio-economic status, family stress and relationships within the families are relevant factors to examine. Assessments of ADHD through the use of rating scales and short-term interventions may lead not only to overdiagnosis but also to a reductionistic approach in the psychiatric field. This literature review aims to address research outside the prevailing discourse on ADHD as an organic brain dysfunction and broaden the perspectives on children's behavioral difficulties. Methods The articles included in this applied, mixed-method, systematic review includes 26 peer-reviewed articles, both English and French, with a search focus on ADHD in children and youth related to Attachment styles and relationships. Results In the studies reported, researchers approached correlations between ADHD and attachment in different ways, and in most cases, there was a caution to address causality. The role of parents was found to be both buffering and aggravating for the appearance of ADHD. In the French case studies, the diagnosis was conceptualized as a relational phenomenon where the child's behavior was inseparable from family member's suffering. Discussion This review article illustrates how children's difficulties in terms of ADHD symptoms can be addressed through a paradigm where emotional and cognitive dysregulation is understood through psychosocial factors rather than as a neurological condition. In our view, to avoid an overly reductionistic and medicalized approach to children's behavioral difficulties, it is time to reiterate the value of the biopsychosocial perspective. Conclusion Professionals and researchers need to acknowledge that becoming diagnosed with ADHD has a strong connection to economic disadvantage, social status, and familial care. The academic discourse of addressing brain dysfunctions might serve the unintended purpose of masking emotional stress and social disadvantage that manifests across generations. A biopsychosocial approach to ADHD including family, emotional history, and socio-economic issues could imply a lesser focus on medical treatment as a first choice.
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Affiliation(s)
- Soly I. Erlandsson
- Department of Social and Behavioral Studies, University West, Trollhättan, Sweden
| | - Christoffer Hornborg
- Department of Sociology and Work Science, Gothenburg University, Gothenburg, Sweden
- Campus Västervik, Västervik, Sweden
| | - Emma Sorbring
- Department of Social and Behavioral Studies, University West, Trollhättan, Sweden
- Campus Västervik, Västervik, Sweden
| | - Nicolas Dauman
- Department of Psychology, Université de Poitiers, Univ Rennes, Univ Angers, Univ Brest, RPPSY, Poitiers, France
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Scott S. Debate: 'A rose by any other name' would smell as sweet - myths peddled about the ills of diagnosing conduct disorders. Child Adolesc Ment Health 2022; 27:302-304. [PMID: 35880324 DOI: 10.1111/camh.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
Using a diagnosis of ODD/CD enables the clinician to apply a huge amount of helpful information about what has caused the concerns and then to offer effective treatment. More often than not, they do not use a diagnostic label with the family; the point is for the clinician to share the expertise. Myths about the nature of psychiatric diagnosis and the harms of a label of ODD/CD are debunked in this article. It is society who stigmatises these individuals because of their antisocial behaviour, and withholding skilfully applied benefits of the accumulated knowledge of the condition is cruel and especially harmful to disadvantaged groups in society where ODD/CD is far more prevalent.
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Affiliation(s)
- Stephen Scott
- Institute of Psychiatry, Kings College London, London, UK
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Honkasilta J, Koutsoklenis A. The (Un)real Existence of ADHD-Criteria, Functions, and Forms of the Diagnostic Entity. FRONTIERS IN SOCIOLOGY 2022; 7:814763. [PMID: 35707639 PMCID: PMC9189308 DOI: 10.3389/fsoc.2022.814763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The contemporary conceptualization of Attention Deficit Hyperactivity Disorder (ADHD) as a complex, multifactorial neurodevelopmental disorder cannot be understood as such without a complex assemblage of political, economic, and cultural processes that deem the conceptualization to be valuable and useful. In this article we use the notion of psychiatrization as a lens through which to see parts of these processes that make up ADHD what it is. In the first part of the article, we critically assess the scientific basis of the ADHD diagnosis via examining its diagnostic criteria as presented in the current fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the so called "Bible" of modern psychiatry. The second part of the article asks what is done with the ADHD diagnostic entity and with the idea that it represents a natural neurodevelopmental state within an individual-something an individual has-as represented in the DSM-5. Drawn from our previous research, we analyze how ADHD becomes real in discourse practice as a powerful semiotic mediator through analysis of the various functions and forms in which it takes shape in institutional, social, and individual levels. We conclude that the frequent changes in the diagnostic criteria of ADHD do not reflect any real scientific progress. Among other reasons, they change to match better the maneuvers of individuals when navigating an increasingly psychiatrized society in the search for recognition, support, category membership, immunity, sympathy, and sense of belonging.
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Affiliation(s)
- Juho Honkasilta
- Department of Education, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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Koutsoklenis A, Honkasilta J. ADHD in the DSM-5-TR: What has changed and what has not. Front Psychiatry 2022; 13:1064141. [PMID: 36704731 PMCID: PMC9871920 DOI: 10.3389/fpsyt.2022.1064141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
In this article, we critically review the changes made to the DSM-5 Text Revision published in 2022 regarding the diagnostic entity of Attention Deficit/Hyperactivity Disorder (ADHD). We structure our critique around three points. The first discusses the acknowledgment of ADHD as a neurodevelopmental disorder. The second examines the definition of ADHD provided in the updated edition of the manual. The third scrutinizes the changes in the diagnostic criteria for ADHD and assesses whether these changes make the diagnosis more accurate. We conclude that DSM's latest edition does not escape the logical and scientific pitfalls of its predecessor. DSM-5-TR keeps the faith in the neo-Kraepelinian paradigm by explicitly and implicitly cultivating the essentialist medical scientific metaphor of disorder, creating the illusion that it represents scientific progress that validates ADHD as a neurodevelopmental disorder.
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Affiliation(s)
| | - Juho Honkasilta
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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Batstra L, Foget L, van Haeringen C, Te Meerman S, Thoutenhoofd ED. What children and young people learn about ADHD from youth information books: A text analysis of nine books on ADHD available in Dutch. Scand J Child Adolesc Psychiatr Psychol 2021; 8:1-9. [PMID: 33520773 PMCID: PMC7685495 DOI: 10.21307/sjcapp-2020-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is not a singular concept. For the purposes of this study, understandings of ADHD are assumed also to spread along a conceptual dimension that includes some combination of biomedical and psychosocial knowledge. Biomedically, ADHD may be considered a somatic affliction causing inattention and hyperactivity, amenable to pharmaceutical treatment. Psychosocially, ADHD ranks among adverse behaviour patterns that are amenable to psychosocial and pedagogical intervention. Considering both biomedical and psychosocial factors are associated with the ADHD construct, it seems self-evident that young people should be offered information that gives equal consideration to both ways of addressing ADHD, but the question is just how balanced the information available to young people is. This study investigated nine information books on ADHD available in the Netherlands in Dutch, aimed at children and young people up to age 17. Thirteen perspective-dependent text elements were identified in qualitative content analysis. Eight attributes associate with a biomedical view: ADHD as cause, biological factors, clinical diagnosis, brain abnormality, medication, neurofeedback, heritability and persistence. Five text elements associate with a psychosocial view: ADHD as perceived behaviour, environmental factors, descriptive diagnosis, behavioural intervention and normalisation. The most frequent text passages encountered describe ADHD as a brain abnormality, along with medical and behavioural treatment. Providing the main focus for information in eight out of nine books, biomedical information about ADHD predominates in the available youth information books, while psychosocial information about ADHD is far less well covered.
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Affiliation(s)
- Laura Batstra
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Linda Foget
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Caroline van Haeringen
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Sanne Te Meerman
- Youth, Education and Society, Centre of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, The Netherlands
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Dauman N, Haza M, Erlandsson S. Liberating parents from guilt: a grounded theory study of parents' internet communities for the recognition of ADHD. Int J Qual Stud Health Well-being 2019; 14:1564520. [PMID: 30696381 PMCID: PMC6352942 DOI: 10.1080/17482631.2018.1564520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study presents a qualitative analysis of information posted on the Internet by two communities of French parents promoting the recognition of ADHD in the context of current health and school practices. METHOD Grounded Theory (Strauss & Corbin's approach) was applied to the posted messages, with the aim to discover the main concern and common theme through a constant comparison analysis. RESULTS Liberating parents from feeling responsible for their child's misconduct was found to be the core category. From this perspective, we account for the commitment of the digital communities to formalize the child's conduct as a consequence of a neurodevelopmental disorder. This approach helps to account for the promotion of behavioural expertise and conditioning strategies (e.g., positive reinforcement) for handling the child's so-called disorder as appropriate parental responses. Giving evidence for parenting struggles was the third main concern of the communities, in the face of perceived skepticism from professionals towards ADHD as a medical condition. CONCLUSIONS By using examples from countries that are found to have a more pro-medical approach to ADHD, the communities aim at improving such medical practices in France. Issues surrounding the claim that ADHD would require a specific style of parenting are also discussed.
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Affiliation(s)
- Nicolas Dauman
- Department of Psychology, University of Poitiers, Poitiers, France
| | - Marion Haza
- Department of Psychology, University of Poitiers, Poitiers, France
| | - Soly Erlandsson
- Centre for Child and Youth Studies, University West, Trollhättan, Sweden
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Leitch S, Sciberras E, Post B, Gerner B, Rinehart N, Nicholson JM, Evans S. Experience of stress in parents of children with ADHD: A qualitative study. Int J Qual Stud Health Well-being 2019; 14:1690091. [PMID: 31713473 PMCID: PMC6853214 DOI: 10.1080/17482631.2019.1690091] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/01/2022] Open
Abstract
Purpose: Qualitative research aimed at understanding the stress of parents of children with ADHD is limited and few interventions have been designed to directly target their stress. The study aim was to explore the stress of parents of children with ADHD using qualitative methodology.Methods: Thirteen parents of children with ADHD participated in two focus groups. Open-ended questions explored parents' experiences of stress. Focus groups were recorded, transcribed, and coded using thematic analysis. Parents also completed the Parenting Stress Index-Short Form.Results: Four primary themes were identified: The child's behaviour feels like a "wrecking ball"; Coping with the "war at home"; A divided family: "relationships don't survive"; and Craving support: "it's goddamn hard work". Five of eleven participants who completed the PSI-SF scored in the clinically significant range indicating levels of stress that require professional support.Conclusions: Parents attribute their high stress to their children's behaviour, unmet needs for support, and social stigma. Parents request support to enable them to cope and appear to represent a clinical population who require mental health care and support themselves. Future interventions directly targeting the stress of parents of children with ADHD may provide wide-ranging benefits for their children and families.
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Affiliation(s)
- Sophie Leitch
- School of Psychology, Deakin University, Burwood, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Burwood, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Brittany Post
- School of Psychology, Deakin University, Burwood, Australia
| | - Bibi Gerner
- School of Psychology, Deakin University, Burwood, Australia
| | | | - Jan M. Nicholson
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Burwood, Australia
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Wong ICK, Banaschewski T, Buitelaar J, Cortese S, Döpfner M, Simonoff E, Coghill D. Emerging challenges in pharmacotherapy research on attention-deficit hyperactivity disorder-outcome measures beyond symptom control and clinical trials. Lancet Psychiatry 2019; 6:528-537. [PMID: 31122482 DOI: 10.1016/s2215-0366(19)30096-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/24/2022]
Abstract
Although pharmacological therapies are recommended as a key component in the treatment of attention-deficit hyperactivity disorder, their use continues to prompt intense debate. Despite considerable research efforts, several gaps in the knowledge base and several questions over the quality of evidence exist. Particular issues surrounding pharmacological treatments include uncertainties about long-term effectiveness and safety, safety profiles in adults, and the comparative effectiveness of different medications. In this Review, we focus on four key methodological issues for future research: (1) the use of appropriate trial designs; the need for (2) outcome measures targeting effectiveness beyond symptom control and (3) safety outcome measures; and (4) the application of clinical and administrative research databases to assess real-world outcomes. Potential solutions include increased use of randomised placebo-controlled withdrawal trials and large pharmacoepidemiological studies that use electronic health-care records on the long-term effectiveness and safety of medications. Pragmatic head-to-head randomised trials would also provide direct evidence on comparative effectiveness and safety profiles.
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Affiliation(s)
- Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, University College London, School of Pharmacy, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research Maudsley Biomedical Research Centre for Mental Health, London, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, and Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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Karlsson Y. Boys’ socialisation and agency in a Swedish special educational needs unit. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1565435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yvonne Karlsson
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
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13
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Affiliation(s)
- S I Erlandsson
- a Department of Social and Behavioral Science , University West , Sweden
| | - E Punzi
- b Department of Psychology , Gothenburg University , Sweden
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